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Coronary artery disease
Original research article
Drug-eluting stents versus bare-metal stents in acute myocardial infarction with cardiogenic shock
  1. Jakob Ledwoch1,2,
  2. Georg Fuernau1,2,
  3. Steffen Desch1,2,
  4. Ingo Eitel1,2,
  5. Christian Jung3,
  6. Suzanne de Waha1,2,
  7. Janine Poess1,2,
  8. Steffen Schneider4,
  9. Gerhard Schuler5,
  10. Karl Werdan6,
  11. Uwe Zeymer4,7,
  12. Holger Thiele1,2
  1. 1 Department of Cardiology, Angiology, Intensive Care Medicine, University Heart Center Lübeck, Lübeck, Germany
  2. 2 German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
  3. 3 Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
  4. 4 Institut für Herzinfarktforschung, Ludwigshafen, Germany
  5. 5 Clinic for Internal Medicine/Cardiology, University of Leipzig – Heart Center, Leipzig, Germany
  6. 6 Clinic for Internal Medicine III, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
  7. 7 Medical Clinic B, Klinikum Ludwigshafen, Ludwigshafen, Germany
  1. Correspondence to Dr Georg Fuernau, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; georg.fuernau{at}uksh.de

Abstract

Objectives The aim of the present study was to assess the outcome of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) receiving drug-eluting stents (DES) compared with bare-metal stents (BMS). Data comparing these two stent technologies in AMI with CS were limited.

Methods A total of 783 patients with AMI and CS undergoing early revascularisation were included in the randomised Intra-aortic Balloon Pump in Cardiogenic Shock II trial (n=600) and the associated registry (n=183). Patients receiving no stent or both, DES and BMS, were excluded. Primary end point was the composite of 1-year mortality or re-AMI.

Results Of the total cohort, 652 (83%) patients received either solely DES or BMS and were included in the present analysis. Of these, 276 (42%) patients received DES and 376 (58%) received BMS. After adjustment for baseline characteristics, there was no significant difference between DES and BMS regarding the primary end point (HR 0.83 (CI 0.64 to 1.06); p=0.14). There was an independent association of BMS use with older age, atrial fibrillation and coronary single-vessel disease. DES use was associated with prior known dyslipidaemia, baseline haemoglobin level, anterior AMI and treatment at frequently enrolling centres.

Conclusions Despite the frequent use of DES nowadays, a substantial number of patients were treated by BMS in AMI complicated by CS. After adjustment for risk factors, the 1-year outcome of patients treated by DES compared with BMS was similar.

Trial registrationnumber www.clinicaltrials.gov: NCT00491036.

  • Percutaneous coronary intervention
  • Acute myocardial infarction

https://doi.org/10.1136/heartjnl-2016-310403

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    Footnotes

    • Contributors JL, GF: manuscript writing, analysis and interpretation of the data, statistical analysis, conception and design of study. SD, GS, IE, KW, UZ, HT: revising the manuscript critically for important intellectual content, analysis and interpretation of the data, conception and design of study. CJ, SW, JP, SS: revising the manuscript critically for important intellectual content, analysis and interpretation of data. 

    • Funding The trial was supported by grants from the German Research Foundation, the German Heart Research Foundation, the German Cardiac Society, Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte, the University of Leipzig Heart Center and by unrestricted grants from Maquet Cardiopulmonary as well as Teleflex Medical.

    • Competing Interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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